Method and apparatus for closed-loop pharmaceutical delivery

ABSTRACT

A method of dispensing a pharmaceutical senses electrical signal representative of a physical condition of a patient and dispenses a therapeutic drug to the patient from a drug delivery appliance in response to either the electrical signal or a second signal from a health care provider.

FIELD OF THE INVENTION

This invention relates to medical devices. In particular, this inventionrelates to medical devices that are used to dispense maintenancepharmaceutical drugs.

BACKGROUND OF THE INVENTION

Many individuals suffer from chronic health problems, such as asthma,epilepsy, cancer, diabetes and allergies, the treatment of whichtypically requires the regular delivery of precise amounts of medicationfor the patient's survival. Optimum treatment of such chronic illnessesfrequently requires that therapeutic drug dosing to a patient change inresponse to certain patient conditions. Unlike the human body's abilityto regulate itself, most medical treatments are administered somewhat“open-loop.” In other words, there is no continuous and immediatesensing of the effect of a dosage by which subsequent dosages arechanged.

Many present-day chronic illness treatment regimens can be modeled asopen loop systems, i.e., there is no automatic modification oradjustment of a treatment regimen in response to changing patientconditions. Individuals with chronic and expensive-to-treat illnessesmight live better and fuller lives if other drug delivery regimens wereavailable.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a simplified block diagram of an intelligent drug deliveryappliance.

FIG. 2 shows a simplified representation of an intelligent drug deliveryappliance and external sensors and a data network interface.

FIG. 3 shows an alternate embodiment of a networked drug deliveryappliance.

FIG. 4 shows a simplified flow chart depicting a method by which druginteraction can be prevented.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

FIG. 1 shows a simplified block diagram of an intelligent drug deliveryappliance 100 (hereafter the “appliance”). The appliance 100 includes acontrolling processor 102 (e.g., a microcontroller, microprocessor,digital signal processor (DSP), combinational/sequential logic andequivalents thereof), operatively coupled to peripheral devices (via anaddress/data/control bus 112) which include, but which are not limitedto, a pharmaceutical control or dispensing valve or gate 108 of areservoir 104 of a pharmaceutical (e.g. a drug or supply such as ahypodermic needle and syringe). The appliance 100 might be implantedinto a patient but it might also be used as an in vitro device in apatient's home, hospital room or other location whereat treatment isadministered or received.

The reservoir 104 can contain one or more supplies of controlled ormedicinal substances such as tablets, liquids, gases, intended to beadministered to a patient according to a treatment regimen (i.e. aprescription) of a medical professional (i.e. a doctor, not shown). Thereservoir 104 might also store dispensable supplies, such as syringes,reagent test strips (for blood glucose testing for example)antihistamine tablets and the like, also to be used according to someprescribed treatment regiment. For purposes of claim construction, anysubstance or consumable supply item that might be dispensed to, or usedby, a patient is hereafter referred to as a “pharmaceutical.”

One specific example of a pharmaceutical, which might be controllablydispensed, is an aerosol or atomized mist of liquid anti-histamine. Byusing ink-jet print head technology, very precise amounts of liquids canbe controllably dispensed under software control. As the amount ofmedication is used, the amount remaining in a reservoir can be readilydetermined.

In a drug delivery appliance such as that shown in FIG. 1, a treatment“regimen” (which is a schedule or circumstance according to which apharmaceutical is taken by, or administered to a patient from the drugdelivery appliance 100) is embodied as computer program instructions(and/or data) stored in a memory device 114 such as random access memory(RAM), electrically erasable programmable read only memory (EEPROM) orthe like, within the appliance. Data parameters that the programoperates on, or under the control of, are also stored in a memory device114. By executing stored program instructions, the controller 102 canreliably administer pharmaceuticals according to a doctor's treatmentregimen, the parameters of which can be changed by changing various datastored in memory 114.

By way of example, the program stored in ROM/EEPROM memory 114 (orpossibly stored within memory of the processor 102 itself) caneffectuate the administration of the aforementioned antihistamine (anexample of a “pharmaceutical”) from the reservoir 104 to a patient overa predetermined time interval (e.g., hourly, daily, weekly) or, foremergencies, upon patient demand, by opening a valve or gate or otherdispensing mechanism 108 for a predetermined amount of time so that acertain amount of the pharmaceutical can be delivered (e.g. flow) fromthe reservoir 104 to a patient through the valve, (or gate or dispensingmechanism) 108. A drug regimen can also limit the amount of medicinedispensed to a patient according to amounts previously dispensed overtime. In such instances, over-doses can be avoided or eliminated bysoftware or program dosage limits stored in memory.

Many drugs affect measurable conditions of a person's body. If aprescribed drug is known to affect one or more measurablecharacteristics such as temperature, heart rate, blood pressure or othercharacteristics, actively monitoring the characteristic(s) andmodulating a drug therapy in real time can yield better patient care.

In a preferred embodiment, patient condition sensors 109 (one shown inFIG. 1) detect measurable characteristics (quantities) such as heartrate, blood pressure, blood sugar, temperature, electrocardiogram,encephalograph signals and waveforms are operatively coupled to theprocessor so as to provide real-time data signals that arerepresentative of a patient's physical condition. For purposes of claimconstruction however, the data signals from patient condition sensorsthat are “representative of a patient's physical condition” should notbe construed to include manually controlled electrical signals, such asthose generated by a manually-operable switch closure in prior artdevices, such as on-demand morphine delivery pumps and patient-operablepush-button switches by which drug administration is controlled orcontrollable using the manual switch closure. The term “signalsrepresentative of a patient's physical condition” should be consideredto refer to electrical signals (digital or analog) that are generated byelectronic circuitry in response to or monitoring autonomic physicalconditions such as temperature, heart rate, blood pressure, brain waveactivity, blood sugar and the like.

In addition to patient conditions, in another embodiment, information ordata about atmospheric or environmental conditions, which can affect apatient's health or well being, are also considered to be signalsrepresentative of a patient's physical condition. Examples of theinformation representative a patient's (actual, expected or anticipated)condition would include information on barometric pressure or pressurechanges, allergen counts if such allergens might adversely affect thepatient's health Environmental conditions such as ozone levels,humidity, ambient temperature, ultraviolet (UV) levels, pollen counts,mold spore counts and the like (for geographic regions) all of which arereadily available from third parties, such as the National WeatherService.

By way of example, knowing or anticipating that ozone, UV levels orallergen counts are high, low, likely to increase or likely to decreasewould enable drug dosage for afflictions to be adjusted before theactual increase or decrease occurred thereby providing for betterpatient care. In such an embodiment, the administration of one or moretherapeutic medicines from the reservoir 104 by the processor 102 canthen be modulated under software control in response to the informationfed back by sensors 109 so as to provide optimal control of a patient'shealth. Environmental conditions or predicted changes can be obtained bythe appliance 100 by way of web-hosted communications between theappliance and the web site of a data provider through the appliance'sdata communication port(s) 120, 123. E-mail or FTP file transfers alsoprovide a mechanism by which health-affecting data can be obtained bythe appliance in real time.

Patient treatment regimens that are executed by the processor within theappliance 100 and stored in the appliance 100 memory 114 can also bemonitored or modified under the external control of a health careprovider (not shown). Sensed data parameters, (such as temperature,heart rate and brain wave activity, etc., read from external sensors)can be forwarded to a health care service provider by the appliance 100using well-known data transfers accomplished via either the wirelessdata interface 120 or a wireline data network interface 123. In oneembodiment, the appliance can log onto a health care service provider'sweb site and send data to the web server for the patient's doctor ornurse. Still other embodiments permit the appliance to log onto a healthcare service provider web site and download treatment regimenmodifications.

When real-time patient data read by the intelligent drug deliveryappliance is forwarded to a health care provider, a treatment regimenstored in the appliance 100 can be adjusted in real-time, in responsethereto, such as by the aforementioned web download, an FTP filetransfer or even instructions telephoned to the appliance 100 user. Drugdosage limits, drug administration timing and/or frequency and the like,which parameters are stored in EEPROM or RAM, can be modified inresponse to patient conditions on a real time basis. By way of example,a patient's dosage of pain medication can be adjusted bysensed-conditions such as brain wave activity, heart rate, temperatureas well as data on atmospheric conditions such as pollen count. Data andinstructions (e.g. to modify a drug dosage) can be transferred to theappliancelOo using web-based (Internet) communication. Data can also betransferredfrom the appliance also be way of web-based data transfers.

In some embodiments, the drug delivery appliance 100 might be remotelylocated from the patient under treatment while the medication and dosageequipment remains proximate to the patient. FIG. 3 shows a simplifiedblock diagram of an alternate embodiment wherein the drug deliveryappliance 100 is remotely located from the patient-located equipment 302but the drug delivery appliance 100 communicates with the patientlocated equipment via any appropriate data communications medium.

In FIG. 3, the intelligent drug delivery appliance 100 can be located ina health care service provider's office or at a nurses station forexample but operatively coupled to patient sensors 202 by a data link206. Inasmuch as the data link requires data it transfers to be in someparticular format (e.g. TCP/IP, Ethernet, ATM, etc.) a personal computer304 or other mechanism for coupling the data network (such as theInternet) to the patient is necessary. In the embodiment shown in FIG.3, the computer 304 acts to convert data to and from the network so asto enable data communications between the remotely located appliance 100and equipment located with the patient. By way of the terminalcapabilities provided by the computer 304, the intelligent drug deliveryappliance 100 can send and receive data to and from the remotely locatedsensors 202. The appliance 100 can also remotely control the delivery ofpharmaceutical from the reservoir 104 by activating the deliverymechanism.

As shown in FIG. 3, sensors such as atmospheric condition sensors 208(pollen, U.V., mold, etc.) can be co-located at the drug deliveryappliance 100. As shown in FIG. 3, atmospheric sensors 208 can also beco-located with the patient equipment whereby patient atmosphericconditions can be determined enabling local atmospheric conditions to bemonitored. In either case, signals (such as patient parameters or localatmospheric conditions) sent over a data network 206 are processed bythe appliance 100 to render a pharmaceutical dosage. One a dosage isdetermined, the appliance's responsive signal can be carried over thenetwork 206 to the patient-located dispensing equipment 108, 104. Bylocating the sensors 208 at the remotely located drug delivery appliance100, expensive atmospheric monitoring equipment can be used withouthaving to co-locate such equipment at several patient locations. Dataobtained by the sensors can be used to adjust medication dosages bysignals sent to the dispensing equipment 104, 108 by way of datamessages exchanged across the network 206. For purposes of claimconstruction , the remote processing by the appliance 100 is consideredto be equivalent to the local processing using the embodiment shown inFIG. 2.

With respect to FIG. 1, a human/display interface 111 is operativelycoupled to the processor 102 via the address/control and data bus 112.Real-time status information (on patient vital signs as well aspharmaceutical availability information or the detection of anoperational failure of the drug dispensing appliance) can be displayedto an operator on the human/display interface 111, which could beembodied as a screen such as a CRT or LCD, which for simplicity aregenerically considered to be the human/display interface 111. Appliancestatus information (battery status; time of day; diagnostic status) canalso be displayed under software control by the processor 102.

As part of the human/display interface, a keyboard or other tactileinput device or speech recognition device can be used to input queriesto the processor, such as a request to run diagnostic software or todisplay the amount of pharmaceutical that remains in the reservoir. Akeyboard or other input device (e.g., push-button, softkey) can also beused to modify pharmaceutical dosing, providing for example, thecapability of delivering an on-demand bolus of pharmaceutical, such asfor allergy treatment.

For the visually-impaired, a speech synthesizer (not shown) can beemployed to enunciate statistics and other information that wouldotherwise be displayed. Well-known speech recognition techniques(requiring a microphone input, audio processing and a data base (notshown) of recognizable words, all of which are well known) can be usedin place of tactile/switch input devices.

Information, such as the volume of pharmaceutical remaining can becritically important to maintaining patient care. A patient-appropriatewarning can be made so as to prevent unexpected depletion of atherapeutic. An audible alarm, flashing light or a combination thereofcan be employed to alert an appliance 100 user. For purposes of claimconstruction, all of the foregoing implementations of a human interfaceare considered to be equivalent “human interface devices.”

FIG. 2 shows a simplified block diagram of a closed-loop intelligentdrug delivery system 200. An intelligent drug delivery appliance 100(such as that shown in FIG. 1) includes a control/communications bus 204over which signals between patient parameter sensors 202 (202-1 - 202-6)and a drug delivery appliance 100 are exchanged (bi-directionally) orcarried (uni-directionally). Those skilled in the art will recognizethat the bus 204 could be implemented using different techniques. Forinstance, a microprocessor's address, data and control lines could beused to read data from and write data to the sensors 202. Well-knowncontrol busses, such as a “USB” (Universal Serial Bus) RS 232, SCSI orHPIB (Hewlett-Packard Interface Bus) are but a few examples of otherprotocols by which data could be sent to and/or received from sensors202.

The sensors 202 shown in FIG. 2 by simplified diagrammaticrepresentations include an electrocardiogram (EKG /EEG) sensor 202-1. Asis known by those skilled in the medical arts, an EKG includes waveformsthat model or represent cardiac rhythm. EKG waveform anomalies canindicate a variety of cardiac problems, many of which are veryresponsive to drug therapy which can be administered by the appliance100.

EKG waveforms are time-varying signals that are obtainable usingelectrodes attached to the patient. Signals from the electrodes (notshown) would represent raw data that requires appropriate processing bythe appliance 100 (or another processor) such that the time-varying EKGwaveforms can be analyzed to detect normal or abnormal waveforms.

An electroencephalograph (EEG) 202-1 can be useful to detect brain waveactivity. EEG waveform abnormalities can indicate impending or existingillnesses or stroke for example. EEG waveforms (after processing) can beused to modulate the administration of certain therapeutics.

Blood gas analyzers (e.g., 02,; C0 ₂) 202-2 can be used to adjust thedelivery of respiratory therapy or supplemental oxygen. A patient'stemperature and/or blood pressure can be read using a variety oftechniques 202-3 and, in response thereto, a variety of regulatorymedications be administered. Blood sugar sensors (not shown) or weightsensors 2024 can also be used to monitor a patient and in response toconditions they detect, provide real-time upon which drug therapies canbe adjusted in response to signals sent to drug delivery mechanisms (notshown in FIG. 2) via a control bus 115.

As set forth above in the discussion of FIG. 1, in addition to sensing apatient's vital signs and statistics, information on physical conditionsor stimuli that might affect a patient's health can be obtained fromextrinsic sources can be provided to the drug delivery appliance 100.Data or information on physical conditions that might affect a patient'shealth can include (but are not be limited to) atmospheric levels ofcertain pollutants or irritants such as ozone, humidity, ambienttemperature and ultraviolet light. Actual and/or expected atmosphericlevels of certain allergens such as pollen, mold spores, rag weed andthe like, can also be sent to or read by the appliance 100. Informationregarding ambient conditions might also be read by the appliance 100directly from co-located sensors (not shown). For purposes of claimconstruction, information or stimuli that might affect a patient'shealth includes, but is not limited to: ambient temperature or humidity;ozone; ultraviolet light intensity levels; allergen counts and the like,and are all considered to be “environmental data.” Such data (orinformation) is received by an environmental data collections interface208 from either real-time sensors or third party data providers.

Environmental data can be provided to the drug delivery appliance 100through the environmental data collection interface 208 by way ofthird-party service providers (not shown) such as the National WeatherService. Mold spore and pollen counts are regularly available from thirdparties via web sites on the Internet. Data on allergens and otherenvironmental data can be sent to and/or received by way of a datanetwork 206 (such as the Internet) to an environmental data collectioninterface 208. (The environmental data collection interface 208 can alsoinclude environmental data sensors which directly collect environmentaldata on their own. Examples of such sensors would include thermometers,UV light meters and the like.)

Environmental data tranfers (data transfers of environmental data suchas pollen counts, humidity, temperature, etc.) can be accomplished usingdata transfers, such as those descried in the currently co-pendingpatent application for a “METHOD AND APPARATUS FOR DELIVERING ANDREFILLING PHARMACEUTICALS” which was filed on Mar. 29, 2001, assigned tothe Hewlett-Packard Company, having U.S. patent application Ser. No.09/823188, the teaching of which is incorporated by reference as itrelates to Internet data transfers between an intelligent drug deliveryappliance and a third party service provider.

In a preferred embodiment, environmental data is readily obtained fromthird parties using a variety of data transfer schemes. Web servers ofmeteorological data providers for example might provide such data to theappliance 100 (or make it available for download) if the appliance hasaccess to the Internet 206 via a data link 207. Using the logicaladdresses (URLs) of such web servers, environmental data can berequested and received by the appliance 100 for use in calculating anappropriate dosage of pharmaceutical.

When physically-measurable parameters of a patient's condition,(including environmental data) are read in “real time” (i.e.substantially instantaneously) by the appliance 100, close patientcontrol can be improved by immediately adjusting drug dosages. Drugdosages can be reduced if symptoms abate or are expected to abate,saving the patient unnecessary dosing and saving the patient unnecessarycost. Conversely, drug dosages can be increased, if for example, pollencounts are predicted to rise wherever it is that the patient live.

For patients who take two or more different medications, adverse druginteractions can be avoided using the drug delivery appliance 100 andintelligence programmed into it by way of the stored program control inmemory 105. It is well known that if certain drugs are taken together, apatient can suffer adverse reactions to the drug combinations. A database of impermissible drug combinations stored within the memory 105 canbe scanned using one or more drugs as an index to determine if two ormore prescribed drugs should not be taken together. A treatment regimenfor one or more drugs to be dispensed by the appliance 100 incombination with others that the patient might be taking himself or bythe appliance 100 can be checked against entries in an interactive drugdata base to determine if a drug that a patient is taking will adverselyaffect each other or the patient.

FIGS. 4A and 4B shows a simplified block diagram of the steps of amethod 400 by which drug interaction might be avoided. In step 410, aphysician or other health care service provider identifies a drug to bedispensed. A drug identity can be provided to the drug deliveryappliance 100 by a drug's chemical name or chemical compound as well asits trade name or trademarked name.

A database of the chemical, trade name or trademarked names of drugsthat can be dispensed by the appliance can include with each databaseentry, a data structure (or equivalent) containing the chemical names,trade names or trademark names of drugs that should NOT be dispensedtogether. When a first drug is known, the drug delivery- appliance canquery the patient or health care service provider as in step 412 for thenames of other drugs that the patient is already taking or which he issupposed to take.

If a second drug is being taken as indicated by an affirmative responsein step 414, a database or list of one of the two drugs is searched instep 416 to find one of the two potentially interactive drugs in thedatabase. If one of the potentially interacting drugs is found on thelist (A list of data base entries can be quickly and easily searchedusing a variety of sorting techniques to determine if the drug isincluded, indicating a potential interaction.) as shown in step 418,indicating that at least one of the drugs is on (or in) the database, instep 420, a database, list or data structure of drugs that should not becombined with the first drug is determined.

In step 422, a determination that the second drug is listed in thedatabase, list or in a data structure of drugs that should not be mixedwith the first drug causes the drug delivery appliance to inhibit drugdelivery of both drugs in step 422. An output warning (e.g., audiblealarm, flashing light, emergency phone call, etc.) in step 424 can bemade via the user interface 111 or another output device.

Returning to step 418, a determination that the first of two or moredrugs is not on (or in) the drug interaction database causes the systemsoftware to determine if the other of the two (or more) drugs is on (orin) the interacting drug data base. Stated alternatively, of two or moredrugs that can potentially interact with each other, both are tested forinteractive drugs.

In step 426, the presence of drug #2 on (or in) the interacting drugdatabase is tested. If drug #2 is on the list, any associated list ordata structure of drugs that drug #2 should not be taken with is queriedin step 428. In step 428, if drug #1 is determined to be on (or in) adata base, list or data structure of drugs that should not be taken withdrug no. 1, drug delivery is inhibited in step 422. If drug #1 is not on(or in) the database, not listed or not in a data structure of drugsthat are not to be taken with drug no. 1, from step 428 the programcontrol passes to step 430 where one or both of the medications can bedispensed.

In performing operations like sorting and listing and comparing using adatabase of chemical names, trade names or trademarks of drugs, eachcompound can be assigned a numerical reference identity whichcorresponds to the drug by its chemical name, trade name or trademark.Searching or sorting numerical entries is computationally faster butmore time consuming for the database to be created. By searching forinteracting drugs, an enhanced level of patient safety can be realized.

A data transfer network such as the Internet 206, as well as local areanetworks or even the public switched telephone network can improvepatient care even further when treatment regimens stored in theappliance can be modified by a health care service provider in responseto real time data forwarded to the health care service provider.

When patient parameters are forwarded to a health care service providervia a data network through the wireless or wireline interfaces (120 and123 respectively), a programmed treatment regimen can be remotelyreprogrammed by data messages sent to the appliance via a network.Web-based data transfers, e-mail or other file transfer protocols enabledata, such as dosing parameters, to be adjusted by sending appropriatedata messages to the appliance 100 via an electronic communication. Byusing the nearly instantaneous data transfer capability and nearlyubiquitous availability of the Internet, maintaining a constant supplyof health care products can be readily realized.

Those skilled in the medical art will appreciate that patient care mightbe improved by controlling dosage of drugs according to real-time data.By using readily-available communications capabilities, the method andapparatus disclosed herein could be even more valuable using appropriatewireless communications technologies. By way of example, data on airborne allergen count predictions could be radio broadcast to the 100appliance via a wireless communications interface 202-5 such as a one ortwo-way pager, cellular telephone, infrared transmitter or receiver orother wireless device. A wireless communications device enabled with theso-called “Bluetooth” communications protocol for example would enablethe system 200 shown in FIG. 2 to be used with other wirelesscommunications devices such that data from the appliance 100 could betransmitted via the wireless interface 202-5 to other equipment (notshown).

1. A method of dispensing a pharmaceutical comprising the steps of:sensing by an intelligent drug delivery appliance, an electrical signalrepresentative of a physical condition of a patient, which is at leastpartially responsive to drug therapy; measuring said first electricalsignal by said intelligent drug delivery appliance (“appliance”);dispensing a therapeutic drug to said patient from said intelligent drugdelivery appliance in response to at least one of: the appliance'smeasurement of said first electrical signal; a second input signal froma health care provider.
 2. The method of claim 1 wherein said step ofsensing a physical condition of a patient includes at least one of:sensing blood pressure of a patient; sensing heart rate of a patient;sensing the temperature of a patient; sensing blood sugar of a patient;sensing brain wave activity of a patient; sensing allergens; sensingpatient weight.
 3. A method of dispensing a pharmaceutical comprisingthe steps of: sensing an electrical signal representative of a physicalcondition of a patient, which is at least partially responsive to drugtherapy; measuring said first electrical signal by an intelligent drugdelivery appliance (the “appliance”); dispensing a therapeutic drug tosaid patient from said intelligent drug delivery appliance in responseto at least one of: the appliance's measurement of said first electricalsignal, a second input signal from a health care provider; and adjustingthe dosage of the therapeutic drug in response to said sensed physicalcondition.
 4. The method of claim 3 wherein said step of dispensing anappropriate therapeutic drug to said patient in response to thecomputer's measurement of said first electrical signal, said computer isfurther comprised of the step of: adjusting the dosage of thetherapeutic drug in response to the value of said first electricalsignal.
 5. The method of claim 3 further including the step of: limitingthe dispensing of at least some of said therapeutic drug according tothe amount of therapeutic drug previously dispensed in a predeterminedtime interval.
 6. The method of claim 3 wherein said second input signalis a data signal from a health care service provider received at saidappliance via a data network.
 7. A method of dispensing therapeuticdrugs to a patient comprising the steps of: sensing, at least onephysical condition of a patient, which condition is at least partiallyresponsive to drug therapy; converting, said at least one sensedphysical condition to an electrical signal representative of said sensedphysical condition, which is readable by the intelligent drug dispensingappliance; measuring said electrical signal by the intelligent drugdelivery device; adjusting the dosage of the therapeutic drug by theintelligent drug delivery appliance in response to the value of saidfirst electrical signal; dispensing said therapeutic drug to saidpatient from an intelligent drug delivery appliance according to saidstep of adjusting the dosages.
 8. The method of claim 7 wherein saidstep of sensing a physical condition of a patient includes at least oneof the steps of: sensing blood pressure of a patient; sensing heart rateof a patient; sensing body temperature of a patient; sensing blood sugarof a patient; sensing brain wave activity of a patient; sensingallergens to a patient; sensing patient weight.
 9. The method of claim 7further including the step of: adjusting the dispensing of at least someof said therapeutic drug according to the amount of therapeutic drugpreviously dispensed in a predetermined time interval.
 10. The method ofclaim 7 further including the step of receiving at said intelligent drugdelivery appliance, a data signal from a data network, said signaladjusting the dosage of said therapeutic drug.
 11. A method ofdispensing therapeutic drugs to a patient comprising the steps of:determining a first therapeutic drug to be dispensed; determining asecond therapeutic drug to be dispensed; determining if at least one ofsaid first and second therapeutic drugs interacts with either of saidsecond and first therapeutic drug respectively; inhibiting theadministration of said first and second therapeutic drugs if either ofis determined to be interactive with the other.
 12. The method of claim11 wherein said step of determining if at least one of said first andsecond therapeutic drugs interacts with either of said second and firsttherapeutic drug includes sorting database entries for interacting druglistings for said first and second therapeutic drugs.
 13. The method ofclaim 11 further including the step of generating an alarm signal afterthe step of inhibiting.
 14. An drug dispensing appliance comprising: acontroller capable of executing a stored computer program by which drugsare controllably dispensed; at least one therapeutic drug reservoir,operatively coupled to said controller and having at least onepharmaceutical to be dispensed to a patient; a data network interfacecoupled to said appliance; a plurality of patient parameter sensorsoperatively coupled to said controller; whereby therapeutic drugs can becontrollably dispensed from siaid therapeutic drug reservoir under thecontrol of the stored computer program and patient treatment informationsent and received via the data network interface.
 15. The drugdispensing appliance of claim 14 wherein said data network interfaceincludes wireless communications interface.
 16. The drug dispensingappliance of claim 14 further including an environmental datacollections interface operatively coupled to said controller andproviding environmental data thereto. 17-22. (canceled)